Prior Authorization Coordinator RCM

VITAS Healthcare•Miramar, FL

3d•Hybrid

About The Position

The Prior Authorization Coordinator position is located in Miramar, Florida. The role ensures the quality and accuracy of patient insurance information, including certification periods, billing addresses, policy numbers, and authorization numbers. The coordinator prioritizes and processes incoming insurance verifications and prior authorization requests. This involves verifying patient Medicaid, private insurance, and self-pay payor sources via telephone or online systems. The role also includes obtaining authorizations from private insurance and other payor sources requiring authorization via telephone, facsimile, or online systems, while maintaining compliance with medical record confidentiality regulations. The coordinator maintains authorizations extensions for all patients as appropriate and refers requests requiring clinical judgment to the Prior Authorization Supervisor and clinical support staff. They obtain information from agencies when necessary to assist with receiving authorizations and re-authorizations. Additionally, the coordinator assists other departments and Care Centers with client and payor information for accuracy, enters hospice benefit information into the Registration Tool and patient accounting system, and responds to inquiries regarding outstanding referrals and/or authorization information. Administrative support to the department is also provided as needed. The role involves completing Payor Information Forms (PIF) and Payor Change Request Forms (PCR) for accurate reimbursement and updating the Contracting Coordinator of payor information changes. The coordinator also communicates efficiently and effectively to resolve issues pertaining to verification and authorization processes and accesses Medicare's Common Working File (CWF) to verify eligibility if a patient has termed coverage with a private insurance carrier.

Requirements

At least two years of related healthcare Revenue Cycle experience, preferably within registration and financial clearance.
Understanding of medical terminology and clinical documentation.
Clear understanding of the impact insurance verification and prior authorization has on Revenue Cycle operations and financial performance.
Demonstrated knowledge of commercial insurance carriers' guidelines and criteria of verification, authorization and reimbursement.
Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.
Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
Demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
Ability to prioritize and effectively anticipate and respond to issues as they arise.

Responsibilities

Ensures quality and accuracy of patient insurance information, including certification periods, billing addresses, policy numbers, and authorization numbers.
Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests.
Verifies patient Medicaid, private insurance, and self-pay payor sources via telephone or online systems.
Obtains authorization from private insurance and all other payor sources requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations.
Maintains authorizations extension for all patients as appropriate.
Refers authorization requests that require clinical judgment to Prior Authorization Supervisor and clinical support staff.
Obtains information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources.
Assists other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.
Enters all hospice benefit information into Registration Tool and patient accounting system.
Responds to calls, emails and other inquiries regarding the status of outstanding referrals and/or authorization information.
Provides other administrative support to the department as needed.
Completes Payor Information Form (PIF) and Payor Change Request Forms (PCR) when needed for the purpose of meeting payor and client's needs to ensure accurate reimbursement.
Updates Contracting Coordinator of payor information changes.
Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes.
Communicates efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.
Accesses Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.